Evergreen Nursing & Rehab Center - Olympia Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
505243
Provider Name
EVERGREEN NURSING & REHAB CENTER
Provider Address
430 LILLY ROAD NORTHEAST
OLYMPIA, WA 98506
OLYMPIA, WA 98506
Provider Phone Number
(360) 491-9700
Provider SSA County
330
Provider County Name
Thurston
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
135
Number of Residents in Certified Beds
103
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1976-07-07
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.85825
Reported LPN Staffing Hours per Resident per Day
0.74806
Reported RN Staffing Hours per Resident per Day
0.92864
Reported Licensed Staffing Hours per Resident per Day
1.67670
Reported Total Nurse Staffing Hours per Resident per Day
4.53495
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08252
Expected CNA Staffing Hours per Resident per Day
2.51952
Expected LPN Staffing Hours per Resident per Day
0.62486
Expected RN Staffing Hours per Resident per Day
1.03531
Expected Total Nurse Staffing Hours per Resident per Day
4.17969
Adjusted CNA Staffing Hours per Resident per Day
2.78358
Adjusted LPN Staffing Hours per Resident per Day
0.99365
Adjusted RN Staffing Hours per Resident per Day
0.67022
Adjusted Total Nurse Staffing Hours per Resident per Day
4.37352
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2015-02-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
17
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
128
Cycle 2 Standard Health Survey Date
2014-01-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
128
Cycle 3 Total Number of Health Deficiencies
21
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2013-01-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
92
Total Weighted Health Survey Score
102.00000
Number of Facility Reported Incidents
23
Number of Substantiated Complaints
14
Number of Fines
1
Total Amount of Fines in Dollars
1495
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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